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Cephalosporins

Cephalosporins

NewCeftaroline

See also:
Intravenous Cephalosporin's - Microbiology, Indications, Dosing
First Generation
Cefadroxil
Duricef ®

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ORAL
Dosing (Adults): 1-2 grams per day divided qd or q12h.   

Renal Dosing
:
  [CRCL >50 ]: No change.   [25-50 ]: 1 gram x 1, then 500mg q12h.  [10-25 ]: 1 gram po x 1, then 500mg q24h.  [<10 ]: 1 gram x 1, then 500 mg q36h. Hemodialysis:  1 gram x 1, then 500 mg q36h. Dose should be given after dialysis on dialysis days. Alternatively, give 1 gram after each hemodialysis session plus an additional 1 gram dose q72h.
Cefazolin
Ancef ®

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[Dosing -Usual]: 500mg to 1g IV q8h. 
[Moderate to severe]: 500mg – 1 gram q6-8h. 
[life-threatening]: 1–2 grams q6h. 
[Maximum dosage/day]: 12 grams.

Renal dosing
[CRCL >55 ml/min]: no change.   [35-54 ml/min]: Maximum interval: q8h. 500mg – 1.5g q8h.  [11-34 ml/min]: 500mg – 1.5g x 1, then 0.5 - 1 gram q12h.  [<10 ml/min]: 500 mg - 1 gram q18-24h. Hemodialysis:  500 mg – 1 gram IV q24h. (Give dose post-dialysis on dialysis days.)  PD: 500 mg q12h.
Cephradine
Velosef ®

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ORAL
Dosing (Adults):  250-500 mg every 6-12 hours

Renal Dosing:

[CRCL 10-50 ml/min]: Administer 50% of dose.
[<10 ml/min]:  Administer 25% of dose.
Cephalexin
Keflex ®

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ORAL
Dosing (usual):  250 – 500mg po q6h. 
[Severe infections]: 1 gm q6h. (Maximum: 4 g/day).

Other
Streptococcal pharyngitis, skin and skin structure infections: 500 mg orally q12h.  Uncomplicated cystitis: 500 mg orally q12h. 

Renal Dosing:
[CRCL >30 ]: no changes.  [10-30 ]: 250-500 mg q8-12h.   [<10 ]: 250-500mg q12-24h.  Hemodialysis:  250-500mg q12-24h (Dose should be given after dialysis on dialysis days).
Second Generation
Cefaclor
Ceclor ®

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ORAL
Dosing (Adults): 250–500 mg orally every 8 hours or if the extended release form is used: 375–500 mg every 12 hours.    

Renal dosing:
  [CRCL >10 ]: no change.   [<10 ]: Give 50% of usual dose at same interval.   Hemodialysis: 250mg q8-12 hours. Make sure dose is given after dialysis.
Cefotetan 

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Dosing (Adults): 1-2 grams q12h. 
[Life-threatening]: 3 grams IV q12h.
Renal Dosing:
[CRCL >30 ml/min]: No changes.   [10-30 ]: 1-2g q24h or 500mg-1g q12h.   [<10 ]: 1-2 grams q48h or 250-500mg q12h.   Hemodialysis: 250 - 500 mg q24h on non-HD days and 500 mg - 1 gm q24h on HD days.  PD: 1 gram q24h
Cefoxitin
Mefoxin ®

 

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Dosing (Adults): [Uncomplicated]: 1 gm q6-8h. [Moderate to severe]: 1 gram q4h or 2 gm q6-8h. 
[Life-threatening]: 2 gm q4h or 3 gm q6h.
Renal Dosing:
[CRCL >50 ml/min]: No changes.   [30-50 ]: 1-2 grams q8-12 hours.    [10-29 ]: 1-2 grams q12-24 hours.  [5-9 ]: 0.5 - 1 gm q12-24h.   [<5 ]: 0.5 to 1 gram q24-48h.   Hemodialysis: 500mg to 1 gram q24-48h. Also, give a supplemental dose after each dialysis (usual dose: 1 gram).  PD: 1 gram q24h
Cefprozil
Cefzil ®

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ORAL
Dosing (Adults): 250 – 500 mg po q12h. 
Specific guidelines: Pharyngitis/tonsillitis: 500 mg orally every 24 hours x 10 days.  Secondary or acute exacerbation of chronic bronchitis: 500 mg orally every 12 hours x 10 days.

Renal Dosing:
[CRCL >30 ]: No changes.    [<29 ]: 50% of usual dosage q12-24h.   Hemodialysis:  50% of usual dosage q12-24h. (Administer after the completion of hemodialysis on dialysis days).
Cefuroxime
Zinacef ®

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Dosing (Adults): 750 mg to 1.5 gm IV q8h.

Renal Dosing:
[CRCL >20 ml/min]: no changes  (750 mg to 1.5 gm IV q8h).  [10-20 ]: 750 mg q12h.   [<10 ]: 750 mg q24h.  Hemodialysis:  750mg q24h. Repeat the dose at the end of dialysis.   PD: 750 mg q24h.
Cefuroxime axetil
Ceftin ®

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ORAL
Dosing (Adults): 250 – 500mg orally q12h. 

Renal Dosing:
[CRCL >10 ml/min]: no changes.   [<10 ]: give 250mg q24h.   Hemodialysis:  Give 250 mg q24h. Repeat the dose after dialysis.
loracarbef Lorabid ®

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ORAL
Dosing (Adults): Skin and soft tissue infections: 200 mg orally every 12 hours x 7 days.    Uncomplicated urinary tract infections: 200 mg once daily for 7 days.    Uncomplicated pyelonephritis: 400 mg orally  every 12 hours for 14 days.   Pharyngitis/tonsillitis:  200 mg orally every 12 hours for 10 days.  
Sinusitis
: 400 mg orally every 12 hours for 10 days.
  Upper/lower respiratory tract infection: 400 mg orally every 12 hours for 7-14 days.

Renal Dosing:
[CRCL >50 ml/min]: no changes.  
[CRCL 10-49 ml/min]: Administer 50% of usual dose at usual interval or usual dose given half as often.
[CRCL <10 mL/min]: Administer usual dose every 3-5 days.
[Hemodialysis]: Doses should be administered after dialysis sessions.

Supplied:  200 mg, 400 mg capsule.   Powder for oral suspension: 100 mg/5 ml (100 ml); 200 mg/5 ml (100 ml).

Third Generation
Cefdinir
Omnicef ®

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ORAL

 

Dosing (Adults): 1) Acute exacerbations of chronic bronchitis, pharyngitis , tonsillitis: 300 mg orally twice daily for 5-10 days or 600 mg once daily for 10 days.   2) Community-acquired pneumonia, uncomplicated skin and skin structure infections: 300 mg orally twice daily for 10 days.    3)  Acute maxillary sinusitis: 300 mg orally twice daily or 600 mg once daily for 10 days  

Renal Dosing:
  [CRCL >30 ml/min]: no change.  [<30 ]: 300 mg q24h. Hemodialysis:  Give 300mg qod. On dialysis days, give 300mg after dialysis.
Cefixime
Suprax®

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ORAL
Dosing (Adults): 400 mg orally once daily or 200mg twice daily. 
Uncomplicated cervical/urethral gonorrhea due to N. gonorrhoeae:400 mg orally x 1.

Renal Dosing: 
[CRCL >60 ml/min]: no change.   [21-60]: Administer 75% of the standard dose.  [<20 ml/min]: Administer 50% of the standard dose.
Cefoperazone
Cefobid ®

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Dosing (Adults): 1-2 grams q8-12 hours. 
Renal dosing: no changes needed.  Hemodialysis: No changes needed. (Ideally, dosage should be scheduled following a dialysis period).
Cefotaxime
Claforan ®

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Dosing (Adults): [Uncomplicated]: 1 gram IV/IM q12h. 
[Moderate to severe]: 1-2 grams IV/IM q8h. 
[Severe]: 2 grams IV q6-8h. 
[Life-threatening]: 2 grams IV q4h

Renal Dosing:
[CRCL >50 ml/min]: no change.   [10-50 ]: 1-2 grams q8-12h.   [<10 ] : 1-2 grams q24h.  Hemodialysis:  500mg to 2 grams q24h, plus give a supplemental dose post-dialysis. PD: 1 gram q24h
Cefpodoxime
Vantin ®

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ORAL
Dosing (Adults): 100 to 400 mg orally every 12h hours.

-Acute community-acquired pneumonia and bacterial exacerbations of chronic bronchitis: 200 mg orally every 12 hours x 10-14 days.  -Acute maxillary sinusitis: 200 mg orally every 12 hours x 10 days.   -Skin / skin structure: Oral: 400 mg every 12 hours x 7-14 days.  UTI: 100 mg  orally every 12 hours x 7 days.

Renal Dosing:
[CRCL >30 ml/min]: no changes.   [<30 ]: 100 to 400mg q24h.  Hemodialysis:  Give 100 to 400 mg 3 times per week (after dialysis).
Ceftazidime
Fortaz ®

 

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Dosing (usual): 1 gram IV q8-12 hours. 
[Severe / Life-threatening]: 2 grams q8 hours.  (Max 6 grams/day).

Bone and joint infections: 2 grams IV q12h.
Intra-abdominal or gynecologic infection:  2 g IV q8h.
Meningitis: 2 g IV q8h.
Skin and soft tissue infections: 0.5 to 1 g IV q8h.
UTI: 250-500mg IV q8-12 hours


Renal Dosing:
[CRCL >50 ]: No changes.   [31-50 ]: 1 gram q12h.   [16-30 ]: 1 gram q24h.    [6-15 ]: 500 mg q24h.   [<5 –dialysis]: 500 mg q48h.  Note: all dosages listed for renal insufficiency may be increased by 50% in severe infections.    Hemodialysis:  Loading dose: 1 gram x 1, then 1 gram after each hemodialysis session.   [Alternatively]: Give 1 gram q48h, plus give an additional 1 gram dose after each dialysis session.  CAPD: 1 gram x 1, followed by 500mg q24h.
Ceftibuten
Cedax ®

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ORAL
Dosing (Adults): 400 mg orally q24h.

Renal Dosing:
[CRCL > 50 ]: no changes.   [30-49 ]: 200 mg q24h.   [0-29 ]: 100 mg q24h.  Hemodialysis:  Give 400mg after each hemodialysis session.
Ceftizoxime
Cefizox ®

 

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Dosing (Adults): 1-2 grams IV/IM q8-12 hours. 
[Life-threatening]: 3-4 gm IV q8h or 2 gm q4h.
Renal Dosing:
[CRCL >79 ]: no changes.   [50-79 ]: 500 mg to 1.5 gm q8h.   [5-49 ]: 250mg – 1 gm q12h.   [0-4 – dialysis pt]: 250-500 mg q24h or 500mg to 1 gm q48h.   Hemodialysis:  250-500 mg q24h or 500mg to 1 gram q48h (dosages should be timed after hemodialysis on dialysis days.)  PD: 500mg – 1 gram q24h.
Ceftriaxone
Rocephin ®

 

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Dosing (Adults): 1-2 grams q12-24h.
[Meningitis]: Give 100 mg/kg/day (not to exceed 4 grams) qd or in divided doses q12h.
Other: Gonococcal infection (uncomplicated): 125-250 mg IM x 1.    PID:  250 mg IM x 1.  

Renal Dosing:
No adjustments are necessary, however, blood levels are recommended in dialysis patients. Adults with both renal and hepatic failure should not receive more than 2 gm/day.   Hemodialysis:  No specific recommendations per manufacturer except that blood levels are recommended in dialysis patients. The dosage should not exceed 2 grams per day. Some studies have recommended giving cefriaxone 1 gram q48h making sure the dose is given after hemodialysis on dialysis days.  PD: 750mg q12h.
Fourth Generation
Cefepime
Maxipime ®

 

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Dosing (Adults): [Mild to moderate]: 500 mg to 1 gram IV q12h. 
[Moderate to severe]: 1-2 grams IV q12h. 
[Febrile neutropenic patients]: 2 grams IV q8h.

Renal Dosing: [CRCL >60 ml/min]: no change. [30-60 ]: 500mg to 2 grams q24h. Neutropenic: 2 grams q12h.  [11-29 ]: 500 mg to 1 gram q24h. Neutropenic: 2 grams q24h.  [<11 ]: 250 – 500 mg q24h. Neutropenic: 1 gram q24h. Hemodialysis:  250 – 500 mg q24h. Neutropenic: 1 gram q24h. // Give additional dose post dialysis.  PD: 1-2 grams q48h
Fifth Generation
 

TEFLARO™ (ceftaroline fosamil)

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See local monograph

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   Read the disclaimer
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